- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.49 / $4,889.39 / $7,120.36
| Facility | | $1,506.49 | $4,889.39 | $7,120.36 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,631.25 / $5,631.25 / $5,631.25
| Facility | 50 | $5,631.25 | $5,631.25 | $5,631.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.39 / $600.28 / $1,762.49
| Professional | | $409.39 | $600.28 | $1,762.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.36 / $1,710.17 / $7,104.12
| Facility | | $988.36 | $1,710.17 | $7,104.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.36 / $1,553.00 / $2,052.00
| Facility | | $988.36 | $1,553.00 | $2,052.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |